Instructions For The Completion Of The Second Injury Fund Electronic Funds Transfer Enrollment Form

Completing The Enrollment Form:

You are to complete the unshaded portions of the enrollment form. Please complete the
fields of the form with the following information:

Vendor Name - the name of your company or organization as it
appears on the bank account referenced.

Vendor Address - the mailing address of your organization to
which all payments are sent.

Vendor FEIN/SSN - the Federal Tax Identification Number or Social
Security Number of your organization.

ABA NO/CHCK Digit - the 9-digit routing code of the financial
institution for the specified savings or checking account to which funds will be deposited.
If funds are deposited into your checking account, the routing number usually precedes
your checking account number on the bottom of your checks.

Bank Account Number - the bank account to which funds are to be
deposited.

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This page was last updated on October 16, 2008.